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Venturini S, Still MEH, Hutchinson PJ, Gwinnutt JM. Is Pre-Injury Socioeconomic Status Associated With Outcomes in Patients With Traumatic Brain Injury? A Systematic Review. J Neurotrauma 2024; 41:789-806. [PMID: 38251663 DOI: 10.1089/neu.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
While socioeconomic status (SES) is associated with a variety of health outcomes, the literature on the association between SES and traumatic brain injury (TBI) outcomes has not been formally summarized. This study aims to review existing literature to ascertain whether patients with low SES pre-injury have worse clinical outcomes after TBI compared with those with high SES, in high-income countries. A systematic search was conducted using the MEDLINE, Embase, and PsychINFO databases. Observational studies addressing the association between SES and TBI outcomes (mortality, functional, cognitive, and vocational outcomes) were included (published from 2000, written in English). Both pediatric and adult TBI groups were included. Thirty-two studies met the inclusion criteria. Measures of SES varied across studies. Mortality was assessed in seven studies; five reported an association between low SES and higher mortality. Five of eight studies showed an association between low SES and worse functional outcomes; results for cognitive (n = 13) and vocational outcomes (n = 10) were mixed. The results of this review suggest that SES is a variable of interest in the context of TBI outcomes and should be assessed at time of admission to assist in social work discharge planning and early mobilization of available community resources. Further work is required to better understand the impact of SES on TBI outcomes.
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Affiliation(s)
- Sara Venturini
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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2
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Miller T, Kallenbach MD, Huber DL, Brett BL, Nelson LD. Relationship Between Neighborhood Disadvantage and Mild Traumatic Brain Injury Symptoms. J Head Trauma Rehabil 2023; 38:165-174. [PMID: 36731041 PMCID: PMC9998328 DOI: 10.1097/htr.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the hypotheses that (1) higher neighborhood disadvantage is associated with greater injury-related symptom severity in civilians with mild traumatic brain injury (mTBI) and (2) neighborhood disadvantage remains predictive after controlling for other established predictors. SETTING Level 1 trauma center and affiliated academic medical center. PARTICIPANTS N = 171 individuals with mTBI. DESIGN Prospective cohort study. MAIN MEASURES Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score assessed less than 24 hours and at 2 weeks, 3 months, and 6 months postinjury. Linear mixed-effects models were used to assess the relationship between predictor variables and mTBI-related symptom burden (RPQ score). Neighborhood disadvantage was quantified by the Area Deprivation Index (ADI), a composite of 17 markers of socioeconomic position (SEP) scored at the census block group level. RESULTS Individuals in the upper ADI quartile of the national distribution displayed higher RPQ symptoms than those in the lower 3 quartiles ( P < .001), with a nonsignificant ADI × visit interaction ( P = .903). In a multivariable model, the effect of ADI remained significant ( P = .034) after adjusting for demographics, individual SEP, and injury factors. Other unique predictors in the multivariable model were gender (gender × visit P = .035), health insurance type ( P = .017), and injury-related litigation ( P = .012). CONCLUSION Neighborhood disadvantage as quantified by the ADI is robustly associated with greater mTBI-related symptom burden throughout the first 6 months postinjury. That the effect of ADI remained after controlling for demographics, individual SEP, and injury characteristics implies that neighborhood disadvantage is an important, understudied factor contributing to clinical recovery from mTBI.
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Affiliation(s)
- Tessa Miller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
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Ford K, Hughes K, Cresswell K, Griffith N, Bellis MA. Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16036. [PMID: 36498109 PMCID: PMC9735663 DOI: 10.3390/ijerph192316036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Unintentional injury is a significant cause of disease burden and death. There are known inequalities in the experience of unintentional injuries; however, to date only a limited body of re-search has explored the relationship between exposure to adverse childhood experiences (ACEs) and unintentional injury. Using a cross-sectional sample of the adult general public (n = 4783) in Wales (national) and England (Bolton Local Authority), we identify relationships between ACE exposure and experience of car crashes and burns requiring medical attention across the life course. Individuals who had experienced 4+ ACEs were at significantly increased odds of having ever had each outcome measured. Furthermore, compared to those with no ACEs, those with 4+ were around two times more likely to report having had multiple (i.e., 2+) car crashes and over four times more likely to report having had burns multiple times. Findings expand the evidence base for the association between ACEs and negative health consequences and emphasise the need for effective interventions to prevent ACEs and their impact on life course health and well-being. Such knowledge can also be used to develop a multifaceted approach to injury prevention.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Karen Hughes
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham LL13 7YP, UK
| | - Katie Cresswell
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Nel Griffith
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Mark A. Bellis
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham LL13 7YP, UK
- Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
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Toman E, Hodgson S, Riley M, Welbury R, Di Pietro V, Belli A. Concussion in the UK: a contemporary narrative review. Trauma Surg Acute Care Open 2022; 7:e000929. [PMID: 36274785 PMCID: PMC9582316 DOI: 10.1136/tsaco-2022-000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/03/2022] [Indexed: 11/18/2022] Open
Abstract
Concussion has been receiving an increasing amount of media exposure following several high-profile professional sports controversies and multimillion-dollar lawsuits. The potential life-changing sequalae of concussion and the rare, but devasting, second impact syndrome have also gained much attention. Despite this, our knowledge of the pathological processes involved is limited and often extrapolated from research into more severe brain injuries. As there is no objective diagnostic test for concussion. Relying on history and examination only, the diagnosis of concussion has become the rate-limiting step in widening research into the disease. Clinical study protocols therefore frequently exclude the most vulnerable groups of patients such as those with existing cognitive impairment, concurrent intoxication, mental health issues or learning difficulties. This up-to-date narrative review aims to summarize our current concussion knowledge and provides an insight into promising avenues for future research.
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Affiliation(s)
- Emma Toman
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sam Hodgson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Max Riley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Richard Welbury
- School of Dentistry, University of Central Lancashire, Preston, UK
| | - Valentina Di Pietro
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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5
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Abukhder M, Mobarak D. A retrospective cohort study on the aetiology and characteristics of maxillofacial fractures presenting to a tertiary centre in the UK. Ann Med Surg (Lond) 2022; 77:103622. [PMID: 35638057 PMCID: PMC9142621 DOI: 10.1016/j.amsu.2022.103622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Approximately 3 million facial injuries occur annually, some of which result in maxillofacial fractures. The aim of our study was to evaluate the aetiology and characteristics of maxillofacial fractures presenting to the Queen Elizabeth Hospital in Birmingham. Methods The medical records for 809 patients treated for maxillofacial fractures were retrospectively reviewed between the dates of 01/01/2016 to 30/06/2017. Results A total of 1381 maxillofacial fractures were recorded. The majority of patients were males (n = 682, 84.3%) with a male:female ratio of 5.59:1. The age group with the highest number of admissions was the 26–50 years age group (n = 395, 48.8%). Assaults was found to be most frequent aetiological factor for maxillofacial fractures in the male cohort and falls was the leading cause of maxillofacial fractures in the female cohort. The most common fractured site in our study was the mandible (n = 599, 43.3%) with the angle and symphysis/parasymphysis regions of the mandible being the most susceptible to injury. Teams that were more frequently involved in the care of these patients included ophthalmology (n = 86) trauma and orthopaedics (n = 53), neurosurgery/neurology (n = 95) teams. Conclusion Socioeconomic status plays a significant role in the aetiology of facial fractures. Furthermore, assaults and falls were found to be the leading aetiological factors for maxillofacial fractures in the male and female cohorts respectively. There is a need to develop strategies in preventing falls in care homes, and addressing violence in young people through public awareness campaigns via the public health sector to reduce the incidence of such fractures. This study reported a male predominance in maxillofacial fractures, with the male:female ratio roughly 5.59:1.2. Roughly 79.23% of all maxillofacial fractures occurred between the ages of 16-50 years. The most common fractured site was the mandibular region, followed by the orbit, and the zygomatic region The most frequent aetiological factor was assault, followed by falls, and road traffic accidents. Patients that live in the most deprived 10% of small areas in England made up 32% of all admissions.
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Affiliation(s)
- Munir Abukhder
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Dima Mobarak
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2GW, UK
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Stranjalis G, Komaitis S, Kalyvas AV, Drosos E, Stavrinou LC, Koutsarnakis C, Kalamatianos T. Recent trends (2010-2018) in traumatic brain injury in Greece: Results on 2042 patients. Injury 2020; 51:2033-2039. [PMID: 32536530 DOI: 10.1016/j.injury.2020.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/10/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent analysis on the epidemiology of traumatic brain injury (TBI) within Europe indicates an increase in fall-related injuries and in the incidence of hospitalization among older adults as well as a decrease in contribution of road traffic accidents (RTA). Given the paucity of recent national data, we analyzed TBI-related admissions from the Athens Head Trauma Registry during the largest part of the past decade (2010-2018), a period marked by a profound national socioeconomic crisis. METHODS Demographic and clinical data of admitted TBI patients were collected and analyzed statistically. RESULTS The mean age of patients (N=2042, 68% men) was 59 years (median 64 years). Patient age showed an upward trend across the study period. Most cases were mild, while moderate and severe injuries were indicated in, 11% and 20%, respectively. Falls were the predominant cause of injury (46% of cases), followed by RTA (38%). An upward trend in the frequency of fall-related injury was apparent across the study period; RTA-related injury frequency displayed a downward trend during the second part of the study period. Assault-related injury accounted for 6%. Surgery took place in 11% of cases. In-hospital mortality (IHM) was 21%. Fall-related mortality contributed to 56% of total IHM; RTA-related mortality contributed to 30%. The mean length of hospital stay was 13 days (median: 5 days). CONCLUSIONS The present findings suggest a shift in the epidemiologic profile of TBI patients in Greece with a rise in the proportion of elderly patients, a concomitant increase in fall-related injuries and a reduction in RTA-related injury. They also highlight fall-related injury as the predominant cause of IHM. Our results point towards the urgent need for the intensification of fall prevention strategies, continuing medical education as well as public information campaigns on the risks of geriatric fall-related injury.
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Affiliation(s)
- George Stranjalis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Aristotelis V Kalyvas
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Evangelos Drosos
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Lampis C Stavrinou
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Christos Koutsarnakis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece
| | - Theodosis Kalamatianos
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens 10676, Greece.
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Morrish P, Duncan S, Cock H. Epilepsy deaths: Learning from health service delivery and trying to reduce risk. Epilepsy Behav 2020; 103:106473. [PMID: 31668578 DOI: 10.1016/j.yebeh.2019.106473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Two recent UK reports have highlighted data of concern in relation to potentially preventable epilepsy deaths. Public Health England, an executive agency of the Government Department of Health, using National Health Service data from 2001 to 2014 reported a rise in direct age-standardised mortality for epilepsy-associated deaths, in contrast to a reduction in all-cause deaths over the same period. Premature death was seen in people aged below 50 years, especially in men, and where epilepsy was a contributory cause rather than an association. The Scottish Epilepsy Deaths Study, analysing deaths between 2009 and 2016, similarly found death in those with epilepsy was significantly higher than the matched population below the age of 54, especially between the ages of 16 and 24 (6 times higher). Sudden unexpected death in epilepsy accounted for 38% of epilepsy-related deaths under the age of 45. Both studies found a strong relationship between risk of death and deprivation; we discuss the implications of these and other data for planning service delivery and improving epilepsy care. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.
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Affiliation(s)
| | - Susan Duncan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; Muir Maxwell Epilepsy Centre, University of Edinburgh EH9 1UW, UK
| | - Hannah Cock
- St George's, University of London SW17 0RE, UK; Atkinson Morley Regional Epilepsy Network, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
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Humphries TJ, Ingram S, Sinha S, Lecky F, Dawson J, Singh R. The effect of socioeconomic deprivation on 12 month Traumatic Brain Injury (TBI) outcome. Brain Inj 2020; 34:343-349. [DOI: 10.1080/02699052.2020.1715481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas Jackson Humphries
- Sheffield Institute of Translational Neuroscience (Sitran), University of Sheffield, Sheffield, UK
- University of Sheffield (Medical School), Sheffield, UK
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Sarah Ingram
- Sheffield Institute of Translational Neuroscience (Sitran), University of Sheffield, Sheffield, UK
- University of Sheffield (Medical School), Sheffield, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Fiona Lecky
- Health Services Research, School of Health and Related Research (Scharr), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Jeremy Dawson
- Health Services Research, School of Health and Related Research (Scharr), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Rajiv Singh
- Health Services Research, School of Health and Related Research (Scharr), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
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Long-term survival and five year hospital resource usage following traumatic brain injury in Scotland from 1997 to 2015: A population-based retrospective cohort study. Injury 2019; 50:82-89. [PMID: 30266290 DOI: 10.1016/j.injury.2018.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is unclear if traumatic brain injury (TBI) results in excess mortality compared with head injury without injury to neural structures (HI). Because TBI populations exhibit significant demographic differences from uninjured populations, to determine the effect of TBI on survival, it is essential that a similarly injured control population be used. We aimed to determine if survival and hospital resource usage differ following TBI compared with HI. METHODS This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997 to 2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, a control group of all 194 049 HI cases was also identified. Our main outcome measures were hazards of all-cause mortality for patients with TBI, compared with those with HI, over the 18-year follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation. RESULTS The adjusted odds ratio for mortality in the first month post-injury for TBI, compared with HI, was 7.12 (95% confidence interval [CI] 6.73-7.52; p < 0.001). For the remaining 18-year study period, the hazards of morality after TBI were 0.93 (CI 0.90-0.96; p < 0.001). During the five-year post-injury period, brain injury was associated with 2.15 (CI 2.10-2.20; p < 0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07-1.11; p < 0.001) compared with HI. CONCLUSIONS Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.
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10
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Descriptive Findings of the VA Polytrauma Rehabilitation Centers TBI Model Systems National Database. Arch Phys Med Rehabil 2018; 99:952-959. [DOI: 10.1016/j.apmr.2017.12.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/22/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
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Zoni AC, Domínguez-Berjón MF, Esteban-Vasallo MD, Velázquez-Buendía LM, Blaya-Nováková V, Regidor E. Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain. J Public Health (Oxf) 2018; 39:45-51. [PMID: 26869695 DOI: 10.1093/pubmed/fdw005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. Methods This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. Results A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. Conclusion People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.
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Affiliation(s)
- Ana Clara Zoni
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | | | - María D Esteban-Vasallo
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Luis M Velázquez-Buendía
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Vendula Blaya-Nováková
- Agency for Health Technology Assessment, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Low L, Hodson J, Morris D, Desai P, MacEwen C. Socioeconomic deprivation and serious ocular trauma in Scotland: a national prospective study. Br J Ophthalmol 2017; 101:1395-1398. [PMID: 28274942 PMCID: PMC5629949 DOI: 10.1136/bjophthalmol-2016-309875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
Abstract
Objective To identify the population at risk of serious ocular trauma by exploring relationships with socioeconomic factors. Design National, prospective, population-based, cross-sectional and follow-up study. Participants Patients with serious ocular trauma requiring hospital admission in Scotland. Methods Case definition and ascertainment—cases of serious ocular trauma necessitating admission to hospital under the care of a consultant ophthalmologist were identified using the British Ophthalmological Surveillance Unit reporting scheme. Using the postcode of residence, we assigned a Scottish Index of Multiple Deprivation (SIMD) score, SIMD quintile ( 0%–20% most deprived; 20%–40%, 40%–60%, 60%–80%, 80%–100% least deprived areas), geographical access score as well as the estimated travel time to the nearest general practitioner (GP) practice using either car or public transport for each patient. Population estimates were obtained from the General Register Office for Scotland. Main outcome measure Serious ocular trauma requiring hospital admission. Results A total of 104 patients (85.6% male) were reported as being admitted with ocular trauma with a median age of 32 years (IQR 24–54). There was a trend for increasing incidence of serious ocular injury with increasing socioeconomic deprivation (p=0.034). Patients from the most deprived areas (SIMD: 0%–20%) were twice as likely to sustain ocular injury compared with those from the least deprived (SIMD: 80%–100%) areas (relative risk: 2.19, 95% CI 1.02 to 4.81). There was no significant difference in the drive/public transport time to GP practices across the SIMD quintiles. Conclusions Increasing socioeconomic deprivation was associated with a higher incidence of serious ocular injury. Targeted interventions are needed to address inequality in eye healthcare in deprived areas.
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Affiliation(s)
- Liying Low
- Academic Unit of Ophthalmology, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Daniel Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, Wales, UK
| | - Parul Desai
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline MacEwen
- Department of Ophthalmology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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13
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Corfield AR, MacKay DF, Pell JP. Association between trauma and socioeconomic deprivation: a registry-based, Scotland-wide retrospective cohort study of 9,238 patients. Scand J Trauma Resusc Emerg Med 2016; 24:90. [PMID: 27388437 PMCID: PMC4937548 DOI: 10.1186/s13049-016-0275-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/09/2016] [Indexed: 02/03/2023] Open
Abstract
Background Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland. Methods The study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12. A retrospective cohort study was conducted using secondary data extracted from the national trauma registry. Postcode of residence was used to generate deciles using the Scottish Index of Multiple Deprivation. The incidence rate ratio (IRR) was calculated to allow comparison of incidence of trauma across SIMD deciles. For mortality, observed: expected ratios were obtained using observed mortality in the cohort and expected deaths using probability of survival based on Trauma and Injury Severity Score (TRISS) method. Results Compared with the most deprived decile, the least deprived had an incidence rate ratio (IRR) for all trauma of 0.43 (95 % CI 0.32–0.58, p < 0.001). The association was stronger for penetrating trauma (IRR 0.07, 95 % CI .01–0.56, p = 0.011). There was a significant interaction between age, gender and SIMD. For case fatality, multivariate logistic regression showed that, severity of trauma (ISS > 15) OR 18.11 (95 % CI 13.91 to 23.58) and type of injury (Penetrating versus blunt injury) OR 2.07 (95 % CI 1.15 to 3.72) remain as independent predictors of case fatality in this dataset. Discussion Our data shows a higher incidence of trauma amongst a socioeconomically deprived population, in keeping with other areas of the world. In our dataset, outcome, as measured by in-hospital mortality, does not appear to be associated with socioeconomic deprivation. Conclusion In Scotland, populations living in socioeconomically deprived areas have a higher incidence of trauma, especially penetrating trauma, requiring hospital attendance. Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0275-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Danny F MacKay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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Macleod MR, Smith SJ. Gender and deprivation and rates of referral and thereby admission to a national neurorehabilitation service. Clin Rehabil 2016; 19:109-15. [PMID: 15704515 DOI: 10.1191/0269215505cr812oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the association between gender and deprivation and rates of admission to a national neurorehabilitation facility following subarachnoid haemorrhage or traumatic brain injury. Design: Retrospective analysis of hospital activity data. Setting: Lothian Health Board hospital activity; national neurorehabilitation centre. Subjects: Patients with subarachnoid haemorrhage or traumatic brain injury. Methods: We obtained data for hospital discharge for subarachnoid haemorrhage and traumatic brain injury for patients living in the Lothian Health Board area for the five years 1995 to 1999 by age (15 and over), sex and deprivation category of home residence from nationally held data sets. Similar data were extracted for discharges from the national neurorehabilitation unit. Main measures: Rates of neurorehabilitation admission per 1000 hospital admissions. Chi-squared testing was used to assess statistical significance. Results: Data for 13 338 hospital admissions and 329 neurorehabilitation admissions were available. We observed higher than expected rates of rehabilitation admission for men with subarachnoid haemorrhage and for patients from more affluent postcode sectors with traumatic brain injury. Conclusion: Higher rehabilitation rates are seen among men following subarachnoid haemorrhage and may indicate a focus on return-to-work in the referral or assessment of those suitable for or requiring neurorehabilitation. Higher rehabilitation rates in head injury in those from Carstairs Deprivation Category (DepCat) 2 postcode sectors may represent a bias favouring those from affluent areas in the interaction between the individual and the health service in this group.
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Affiliation(s)
- M R Macleod
- Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, Edinburgh, UK.
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Abstract
OBJECTIVES The aim of our study was to identify the risk factors associated with the development of acute compartment syndrome (ACS) after a fracture of the tibia. DESIGN Retrospective cohort study. SETTING Orthopaedic trauma unit, university teaching hospital. PATIENTS From our trauma database, we identified all patients who sustained an acute tibial diaphyseal fracture over a 13-year period. A retrospective analysis of 1407 patients was performed to record and analyze the OTA fracture classification, open fracture grade according to Gustilo, soft tissue injury classification according to Tscherne, treatment, development of ACS, and other patient demographics including smoking, occupation, and socioeconomic deprivation. MAIN OUTCOME MEASURE A diagnosis of ACS was made using clinical signs, compartment pressure monitoring, or a combination of the 2. RESULTS One thousand three hundred eighty-eight patients were included with a mean age of 39 (12-98) years, and 957 (69%) were male. One hundred sixty patients (11.5%) were diagnosed with ACS. On initial analysis, age, male gender, blue-collar occupation, sporting injury, fracture classification, and treatment with intramedullary nails were predictive of ACS (all P < 0.05). Age was the strongest predictor of developing ACS (P < 0.001), with the highest prevalence between 12-19 years and 20-29 years. Occupation (P = 0.01) and implant type (P = 0.004) were the only factors that remained significant after adjusting for age. On further subanalysis, implant type was not predictive when stratified by Tscherne class (P = 0.11). CONCLUSIONS We have documented the risk factors for the development of ACS after an acute tibial diaphyseal fracture, with youth the strongest predictor. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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van Belle G, Mentzelopoulos SD, Aufderheide T, May S, Nichol G. International variation in policies and practices related to informed consent in acute cardiovascular research: Results from a 44 country survey. Resuscitation 2014; 91:76-83. [PMID: 25524361 DOI: 10.1016/j.resuscitation.2014.11.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/03/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Research in an emergency setting such as that with an acute cardiovascular event is challenging because the window of opportunity to treat may be short and may preclude time to obtain informed consent from the patient or their representative. Some perceive that requiring informed consent in emergency situations has limited improvements in care. Vulnerable populations including minorities or residents of low-income countries are at greatest risk of need for resuscitation. Lack of enrollment of such patients would increase uncertainties in treatment benefit or harm in those at greater risk of need for resuscitation. We sought to assess international variation in policies and procedures related to exception from informed consent (EFIC) or deferred consent for emergency research. METHODS A brief survey instrument was developed and modified by consensus among the investigators. Included were multiple choice and open-ended responses. The survey included an illustrative example of a hypothetical randomized study. Elicited information included the possibility of conducting such a study in the respondent's country, as well as approvals required to conduct the study. The population of interest was emergency physicians or other practitioners of acute cardiovascular event research. RESULTS Usable responses were obtained from 44 countries (76% of surveyed). Community opposition to EFIC was noted in 6 (14%) countries. Emergency Medical Services (EMS) providers in 8 (20%) countries were judged unable or unwilling to participate. A majority of countries (36, 82%) required approval by a Research Ethics Committee or similar. Government approval was required in 25 (57%) countries. CONCLUSION There is international variation in practices and policies related to consent for emergency research. There is an ongoing need to converge regulations based on the usefulness of multinational emergency research to benefit both affluent and disadvantaged populations.
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Affiliation(s)
- Gerald van Belle
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | | | - Susanne May
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Graham Nichol
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA; University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, USA.
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Battle C, Hutchings H, Bouamra O, Evans PA. Social deprivation and adult blunt chest trauma: A retrospective study. J Intensive Care Soc 2014; 16:18-23. [PMID: 28979370 DOI: 10.1177/1751143714552989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The relationship between socioeconomic status and various components of health is well established. Research has also highlighted that social deprivation can affect patterns of injury and outcome after trauma. The interaction between outcomes following blunt chest trauma and socioeconomic status has received limited attention in trauma research. The aim of this study was to investigate the relationship between socioeconomic factors, mechanisms of injury and outcomes following blunt chest trauma using deprivation measures calculated on the basis of domicile postcodes. METHODS A retrospective study design was used in order to examine the medical notes of all blunt chest wall trauma patients who presented to the ED of a large regional trauma centre in South West Wales in 2012 and 2013. Baseline characteristics were presented as median and interquartile range or numbers and percentages. Differences between the baseline characteristics were analysed using Mann-Whitney U test and Fisher's exact test. Odds ratios and 95% confidence intervals were presented from the univariable analysis. Multivariable logistic regression analysis was used to identify significant predictors for the development of complications. RESULTS Patients in the 'more deprived' group were more likely to be the victims of assault (p < 0.001) and were more likely to have an unplanned re-attendance at the Emergency Department than the patients in the 'less deprived' group (p < 0.001). On multivariable analysis, social deprivation was not a risk factor for the development of complications, but it was a significant risk factor for prolonged length of stay (p < 0.05). CONCLUSIONS This is the first study in which social deprivation has been investigated as a risk factor for complications following isolated blunt chest wall trauma. Residing in a 'more deprived' area in South West Wales is not associated with the development of complications following isolated blunt chest wall trauma.
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Affiliation(s)
- Ceri Battle
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
| | | | - Omar Bouamra
- The Trauma and Audit and Research Network, University of Manchester, Salford, UK
| | - Phillip A Evans
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK
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Cook PA, Evans-Jones J, Mallinson H, Wood M, Alloba F, Jones K, Strodtbeck S, Hanna-Bashara L. Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic. BMJ Open 2014; 4:e004862. [PMID: 24633530 PMCID: PMC3963091 DOI: 10.1136/bmjopen-2014-004862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services. DESIGN A retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007-April 2009). PARTICIPANTS All 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM. PRIMARY OUTCOME MEASURE Whether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity). RESULTS 131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02). CONCLUSIONS Community screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas.
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Affiliation(s)
- Penny A Cook
- University of Salford, School of Health Sciences, Salford, UK
| | | | - Harry Mallinson
- Microbiology Laboratory, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Martyn Wood
- Centre for Sexual Health and Contraception, Mid-Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | - Fath Alloba
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Kathy Jones
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Layla Hanna-Bashara
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
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Shivaji T, Lee A, Dougall N, McMillan T, Stark C. The epidemiology of hospital treated traumatic brain injury in Scotland. BMC Neurol 2014; 14:2. [PMID: 24386897 PMCID: PMC3893436 DOI: 10.1186/1471-2377-14-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) is an important global public health problem made all the more important by the increased likelihood of disability following a hospital admission for TBI. Understanding those groups most at risk will help inform interventions designed to prevent causes of TBI, such as falls prevention measures. This study identifies the rate of hospitalisation episodes of TBI in Scotland, explores causes of TBI admissions, and trends in hospitalisation episodes by age and gender over a twelve year period using routinely collected hospital data. Methods A retrospective analysis of routine hospital episode data identified records relating to TBI for the twelve years between 1998 and 2009. Descriptive and joinpoint regression analysis were used, average annual percentage changes (AAPC) and annual percentage change (APC) in rates were calculated. Results Between 1998 and 2009 there were 208,195 recorded episodes of continuous hospital care in Scotland as a result of TBI. Almost half (47%) of all TBIs were the result of falls, with marked peaks observed in the very young and the oldest groups. The AAPC of hospitalization episode rates over the study period for boys and girls aged 0-14 were -4.9% (95% CI -3.5 to-6.3) and -4.7% (95% CI -2.6 to -6.8) respectively. This reduction was not observed in older age groups. In women aged 65 and over there was an APC of 3.9% (95% CI 1.2 to 6.6) between 2004 and 2009. Conclusions Hospitalisation for TBI is relatively common in Scotland. The rise in the age-adjusted rate of hospitalisation episodes observed in older people indicates that reduction of TBI should be a public health priority in countries with an ageing population. Public health interventions such as falls prevention measures are well advised and evaluations of such interventions should consider including TBI hospitalisation as an alternative or supplementary outcome measure to fractured neck of femur. Further research is needed to advance understanding of the associations of risk factors with increased incidence of TBI hospital episodes in the elderly population.
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Affiliation(s)
| | | | - Nadine Dougall
- NMAHP Research Unit, School of Nursing, Midwifery & Health, Unit 13 Scion House, University of Stirling, Stirling FK9 4NF, Scotland.
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Court-Brown CM, Aitken SA, Duckworth AD, Clement ND, McQueen MM. The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am 2013; 95:e321-7. [PMID: 23515993 DOI: 10.2106/jbjs.k.00631] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Social deprivation is associated with many diseases. To our knowledge, there has been no previous investigation of its role in the epidemiology and incidence of fractures in adults. METHODS We analyzed 6872 consecutive fractures in patients fifteen years of age or older over a one-year period. Social deprivation was analyzed using the Carstairs score, which is derived from patients' postal codes and accurately defines social deprivation in our population. RESULTS Social deprivation is associated with an increasing fracture incidence. The effect is not linear, and the most deprived 10% of society are affected. The odds ratios of the most deprived 10% of society having an increased incidence of fractures are 3.7 in males and 3.1 in females. CONCLUSIONS Social deprivation is associated with a significant increase in the incidence of fractures in the most deprived 10% of the population. Most fracture types are affected.
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Affiliation(s)
- Charles M Court-Brown
- Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland.
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21
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Kool B, Chelimo C, Ameratunga S. Head Injury Incidence and Mortality in New Zealand over 10 Years. Neuroepidemiology 2013; 41:189-97. [DOI: 10.1159/000354782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/31/2013] [Indexed: 11/19/2022] Open
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Phang I, Mathieson C, Sexton I, Forsyth S, Brown J, George EJS. Paediatric head injury admissions over a 10-year period in a regional neurosurgical unit. Scott Med J 2012; 57:152-6. [DOI: 10.1258/smj.2012.012021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traumatic brain injury is a leading cause of death and disability in childhood. A retrospective study of all paediatric head injuries admitted to the neurosurgical unit for the West of Scotland over a 10-year period was performed to assess the impact of the National Institute for Health and Clinical Excellence head injury guidelines on the admission rate and to determine the associated risk factors, causes, severity and outcomes of these injuries. There were 564 admissions between 1998 and 2007. The median age at presentation was nine years and two months. There was no change in the admission rate, injury mechanism or severity of head injury admitted over the period studied. A relationship was observed between the Scottish Index of Multiple Deprivation Score and the incidence of head injury ( P = 0.05). Alcohol was reported as a causative factor in only a small number of cases, and moderate to severe head injuries were more commonly identified as a result of road traffic accidents.
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Affiliation(s)
- I Phang
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | - C Mathieson
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | - I Sexton
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | - S Forsyth
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | - J Brown
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | - E J St George
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
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Duckworth AD, Clement ND, Jenkins PJ, Will EM, Court-Brown CM, McQueen MM. Socioeconomic deprivation predicts outcome following radial head and neck fractures. Injury 2012; 43:1102-6. [PMID: 22440531 DOI: 10.1016/j.injury.2012.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/05/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is increasing evidence demonstrating an association between fracture epidemiology and socioeconomic status. However, the influence of socioeconomic deprivation on fracture outcome has not been documented before. The aim of this study was to determine if socioeconomic deprivation influenced the short-term outcome following a fracture of the radial head or neck. METHODS We identified from a prospective database all patients who sustained a radial head or neck fracture over an 18-month period. The primary outcome measure for this study was the patient-reported short musculoskeletal function assessment (SMFA). The Index of Multiple Deprivation (IMD) was used to quantify deprivation, and any correlation with functional outcome was determined. Multivariate regression analysis was used to determine the influence of deprivation on outcome once other significant demographic and fracture characteristics had been accounted for. RESULTS There were 200 patients in the study cohort, of which 107 (53.5%) were female and the mean age was 44 years (16-83). At a mean follow-up of 6 months the median SMFA score was 0.54 (0-55.4). The SMFA was found to be influenced by the IMD, with increasing deprivation associated with a poorer outcome (p=0.006). On multivariate analysis, the AO fracture classification, compensation and increasing deprivation were the only independent predictors of outcome (all p<0.05). CONCLUSIONS We have a shown a clear correlation between functional outcome and socioeconomic status, with the most deprived patients reporting a poorer outcome. Future work should be aimed at determining which aspects of deprivation influence patient outcome, with modifiable factors targeted in future health-care planning.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
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Court-Brown CM, Aitken SA, Ralston SH, McQueen MM. The relationship of fall-related fractures to social deprivation. Osteoporos Int 2011; 22:1211-8. [PMID: 20552329 DOI: 10.1007/s00198-010-1315-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 04/26/2010] [Indexed: 11/30/2022]
Abstract
UNLABELLED The relationship between fall-related fractures and social deprivation was studied in 3,843 patients. The incidence of fractures correlated with deprivation in all age groups although the spectrum of fractures was not affected by deprivation. The average age and the prevalence of hip fractures decreased with increasing deprivation. INTRODUCTION This study examines the relationship between social deprivation and fall-related fractures. Social deprivation has been shown to be a predisposing factor in a number of diseases. There is evidence that it is implicated in fractures in children and young adults, but the evidence that it is associated with fragility fractures in older adults is weak. As fragility fractures are becoming progressively more common and increasingly expensive to treat, the association between social deprivation and fractures is important to define. METHODS All out-patient and in-patient fractures presenting to the Royal Infirmary of Edinburgh over a 1-year period were prospectively recorded. The fractures caused by falls from a standing height were analysed in all patients of at least 15 years of age. Social deprivation was assessed using the Carstairs score and social deprivation deciles, and the 2001 census was used to calculate fracture incidence. The data were used to analyse the relationship between social deprivation and fall-related fractures in all age groups. RESULTS The incidence of fall-related fractures correlated with social deprivation in all age groups including fragility fractures in the elderly. The overall spectrum of fractures was not affected by social deprivation although the prevalence of proximal femoral fractures decreased with increasing deprivation. The average age of patients with fall-related fractures also decreased with increasing social deprivation as did the requirement for in-patient treatment. CONCLUSIONS This is the first study to show the relationship between fall-related fractures and social deprivation in older patients. We believe that the decreased incidence of proximal femoral fractures, and the lower average age of patients with fall-related fractures, in the socially deprived relates to the relative life expectancies in the different deprivation deciles.
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Affiliation(s)
- C M Court-Brown
- Royal Infirmary of Edinburgh, University of Edinburgh, EH16 4SU Edinburgh, UK.
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26
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Factors affecting infection after calcaneal fracture fixation. Injury 2009; 40:1313-5. [PMID: 19524907 DOI: 10.1016/j.injury.2009.03.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/25/2009] [Accepted: 03/25/2009] [Indexed: 02/02/2023]
Abstract
A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined. The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug addicts where there was a significantly increased rate of deep infection. Other factors such as smoking, fracture severity and wound closure did not affect the rate of deep infection. Our study shows that delay prior to calcaneal fracture surgery is not associated with a lower infection rate but it is does indicate that surgical experience is important and we believe that these difficult fractures should be treated in specialised centres.
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Gontkovsky ST, Sherer M, Nick TG, Nakase-Thompson R, Yablon SA. Effect of urbanicity of residence on TBI outcome at one year post-injury. Brain Inj 2009; 20:701-9. [PMID: 16809202 DOI: 10.1080/02699050600744103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the impact of urbanicity of residence and occurrence of medical complications on outcome after traumatic brain injury (TBI). STUDY DESIGN A consecutive series of persons admitted for inpatient TBI rehabilitation followed for 1 year post-injury. SETTING Inpatient brain injury rehabilitation programme in the southeastern US. PARTICIPANTS One hundred and eleven persons with severe (67%), moderate (18%) or mild (15%) TBI. OUTCOME MEASURE Functional status at 2 year post-injury as measured by the Disability Rating Scale (DRS). RESULTS Functional status at follow-up was predicted by age, DRS at admission for rehabilitation, injury severity, alcohol use, continued need for medications and medical complications (validated R2 = 0.57; p < 0.0001). Urbanicity of residence was not predictive of functional status. CONCLUSIONS As expected, participants who experienced more medical complications and required continued use of medications had poorer functional outcomes. Contrary to expectation, more rural residents did not have poorer outcomes than persons residing in more urban areas.
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[Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score]. Presse Med 2009; 38:881-92. [PMID: 19185448 DOI: 10.1016/j.lpm.2008.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 10/27/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability. POPULATION AND METHODS The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex. RESULTS The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability. CONCLUSION The population of the victims of interpersonal violence has a socio-economic profile different from the reference population. Social vulnerability is associated with interpersonal violence, in particular with violence in the public and family area.
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Vassallo JL, Proctor-Weber Z, Lebowitz BK, Curtiss G, Vanderploeg RD. Psychiatric risk factors for traumatic brain injury. Brain Inj 2008; 21:567-73. [PMID: 17577707 DOI: 10.1080/02699050701426832] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the risk of sustaining a traumatic brain injury (TBI) associated with prior psychiatric conditions beyond that of fixed demographic variables. DESIGN Retrospective cohort study of non-referred community-dwelling male US veterans. METHODS Two-hundred and seventy-one individuals who sustained a TBI with altered consciousness were compared with 630 controls without a history of head injury, selected from a larger sample of 3766. RESULTS Hierarchical logistic regression analyses were used to model odds ratios and 95% confidence intervals for the unique association between pre-existing psychiatric disorders and the likelihood of incurring a TBI while adjusting for demographic characteristics and other known predictor variables. Mood (odds ratio 2.48, 95% confidence interval 1.23-5.01), anxiety (OR 1.64, 95% CI 1.01-2.68) and conduct disorders (OR 1.66, 95% CI 1.16-2.38) increased the risk of head injury. CONCLUSIONS The pre-existence of psychiatric illness, particularly depression, anxiety and conduct disorder, increased the future risk of incurring a TBI. The implementation of early identification and treatment of psychiatric conditions may potentially lower risk and reduce yearly incidence rates of TBI.
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Affiliation(s)
- Jessica L Vassallo
- Department of Mental Health and Behavioral Sciences, James A. Haley VAMC. Tampa, FL 33612, USA
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Vanderploeg RD, Curtiss G, Luis CA, Salazar AM. Long-term morbidities following self-reported mild traumatic brain injury. J Clin Exp Neuropsychol 2007; 29:585-98. [PMID: 17691031 DOI: 10.1080/13803390600826587] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to examine the prevalence of long-term psychiatric, neurologic, and psychosocial morbidities of self-reported mild traumatic brain injury (MTBI). A cross-sectional cohort sample of three groups was examined: those who had not been injured in a motor vehicle accident nor had a MTBI (n = 3,214); those who had been injured in an accident but did not have a MTBI (n = 539); and those who had a MTBI with altered consciousness (n = 254). Logistic regression analyses were used to model odds ratios for the association between group and outcome variables while controlling demographic characteristics, comorbid medical conditions, and early-life psychiatric problems. Compared with uninjured controls, MTBI increased the likelihood of depression and postconcussion syndrome. MTBI also was associated with peripheral visual imperceptions and impaired tandem gait. Similarly, the MTBI group had poorer psychosocial outcomes including an increased likelihood of self-reported disability, underemployment, low income, and marital problems. Results suggest that MTBI can have adverse long-term psychiatric, neurologic, and psychosocial morbidities.
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Affiliation(s)
- Rodney D Vanderploeg
- Department of Mental Health and Behavioral Sciences, James A. Haley VAMC, Tampa, FL, USA.
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Court-Brown CM, Brydone A. Social deprivation and adult tibial diaphyseal fractures. Injury 2007; 38:750-4. [PMID: 17306268 DOI: 10.1016/j.injury.2006.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 12/24/2006] [Accepted: 12/05/2006] [Indexed: 02/02/2023]
Abstract
We present an analysis of the relationship between social deprivation and tibial diaphyseal fractures. We reviewed 1331 patients and have demonstrated a clear relationship between social deprivation and tibial fractures. Deprivation was also associated with male gender and with age, there being significantly less deprivation in older patients. The effect of deprivation on fracture outcome was assessed in 910 patients in whom the tibial fractures were treated by reamed intramedullary nailing. There was no association with non-union or infection, but there was a trend towards increased deprivation in patients who had an amputation which related to a trend for socially deprived patients to have more severe fractures. We believe that the main reason why the effects of deprivation decrease with age relates to the different modes of injury at different ages.
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Horton TC, Dias JJ, Burke FD. Social deprivation and hand injury. J Hand Surg Eur Vol 2007; 32:256-61. [PMID: 17335948 DOI: 10.1016/j.jhsb.2006.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Revised: 10/02/2006] [Accepted: 10/10/2006] [Indexed: 02/03/2023]
Abstract
This study investigated the relationship between socioeconomic deprivation and the incidence, patterns of injury, process of care and outcome of hand trauma using data collected prospectively on 1234 injuries presented during six months. The Index of Multiple Deprivation 2004 was derived from census data and postcodes. Socioeconomic deprivation is significantly associated with hand trauma. The odds ratio for suffering hand injuries in the most deprived quintile is 1.6 (SE 0.09 95% CI 1.45, 1.83) compared to the least deprived quintile. This is most marked among older children and adults. Fractures, sprains and ligament injuries showed the strongest association with the degree of deprivation. Injuries related to sport were not associated with deprivation. Surgical time utilised is greater in more deprived patients and their self reported physical outcome is worse. Hand surgery units working in areas of high socioeconomic deprivation will have higher trauma workloads and unit costs. Social deprivation may also influence physical outcomes.
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Affiliation(s)
- T C Horton
- Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby, UK
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Lerner EB, Nichol G, Spaite DW, Garrison HG, Maio RF. A Comprehensive Framework for Determining the Cost of an Emergency Medical Services System. Ann Emerg Med 2007; 49:304-13. [PMID: 17113682 DOI: 10.1016/j.annemergmed.2006.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 09/21/2006] [Accepted: 09/22/2006] [Indexed: 11/28/2022]
Abstract
To determine the cost of an emergency medical services (EMS) system, researchers, policymakers, and EMS providers need a framework with which to identify the components of the system that must be included in any cost calculations. Such a framework will allow for cost comparisons across studies, communities, and interventions. The objective of this article is to present an EMS cost framework. This framework was developed by a consensus panel after analysis of existing peer-reviewed and non-peer-reviewed resources, as well as independent expert input. The components of the framework include administrative overhead, bystander response, communications, equipment, human resources, information systems, medical oversight, physical plant, training, and vehicles. There is no hierarchical rank to these components; they are all necessary. Within each component, there are subcomponents that must be considered. This framework can be used to standardize the calculation of EMS system costs to a community. Standardizing the calculation of EMS cost will allow for comparisons of costs between studies, communities, and interventions.
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Affiliation(s)
- E Brooke Lerner
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
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Nichol G, Powell J, van Ottingham L, Maier R, Rea T, Christenson J, Hallstrom A. Consent in resuscitation trials: benefit or harm for patients and society? Resuscitation 2007; 70:360-8. [PMID: 16908094 DOI: 10.1016/j.resuscitation.2006.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 01/30/2006] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
CONTEXT Research in an emergency setting is challenging because there may not be sufficient opportunity or time to obtain informed consent from the patient or their legally authorized representative. Such research can be conducted without prior consent if specific criteria are met. However consent is sometimes required for continued participation and may bias the results of the study. OBJECTIVE To review regulations related to waiver of consent in emergency research, and evidence of whether such regulations introduce bias. RESULTS Emergency research can be conducted without consent, either through community disclosure and consultation followed by patient or family notification and consent for continued participation after the intervention was applied, or under a minimal risk waiver. Review of the clinical record is necessary to determine important outcomes such as survival to discharge. If consent is required for this review but not granted, then these data are missing during analysis. If seriously ill or disadvantaged patients are less likely to assent, then investigators cannot determine reliably whether these vulnerable patients were harmed by the intervention. If missing data are different from complete data, then the analysis is susceptible to bias, and the conclusions could be misleading. Extrapolation from non-consent rates in resuscitation studies to results from the DAVID trial demonstrates that the rate of absence of data and information due to lack of assent can influence whether there is a significant difference between treatment groups (survival of control versus intervention: p=0.04 for complete data; p=0.08 for 10.8% lack of assent; p=0.40 for 19.7% lack of assent). CONCLUSIONS Exception from consent for emergency research should extend to review of the hospital record as the standard in emergency research. The only potential risk to patients associated with review of the clinical record after the intervention is loss of privacy and confidentiality. Appropriate safeguards can be taken to minimize this risk.
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Affiliation(s)
- Graham Nichol
- University of Washington Clinical Trial Center, Seattle, WA, USA.
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Yates PJ, Williams WH, Harris A, Round A, Jenkins R. An epidemiological study of head injuries in a UK population attending an emergency department. J Neurol Neurosurg Psychiatry 2006; 77:699-701. [PMID: 16464899 PMCID: PMC2117473 DOI: 10.1136/jnnp.2005.081901] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We aimed to identify the attendance rate for all head injuries, and for moderate to severe head injury (MSHI), in an emergency department (ED), and related risk factors for MSHI, including age, sex, area of residence, and socioeconomic status (SES). This was a retrospective descriptive epidemiological study of an ED database of head injury attendances over 6 years, carried out in an ED that serves both urban and mixed rural and urban areas, with a wide socioeconomic range, and a total population of 344,600. The main outcome measure was rates of attendance for head injury. Head injury presentations accounted for 3.4% of all attendances per year. An overall rate of 453 per 100,000 was found for all head injuries, of which 40 per 100,000 were moderate to severe (10.9%). Urban residents had significantly greater risk of presenting with MSHI compared with residents of mixed/rural areas. Males were more at risk than females, and children and adolescents had higher risk of MSHI. A high attendance rate of MSHI was found in the <5 year old age group in urban areas for both sexes. A gradient, with higher attendance in groups with lower SES, was observed for children in urban areas, while the gradient was reversed in mixed/rural areas. Head injuries are a relatively common cause of attendance at ED. There is significant variation in attendance with MSHI with regard to sex, age, socioeconomic factors, and type of area of residence. The planning and delivery of preventative and management services may be improved by such analyses.
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Affiliation(s)
- P J Yates
- Mardon Neuro-Rehabiliation Centre, Royal Devon & Exeter Hospital NHS Foundation Trust, and School of Psychology, Centre for Clinical Neuropsychological Research, University of Exeter, Exeter EX4 4QG, UK
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Tennant A. Admission to hospital following head injury in England: incidence and socio-economic associations. BMC Public Health 2005; 5:21. [PMID: 15748288 PMCID: PMC554988 DOI: 10.1186/1471-2458-5-21] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 03/04/2005] [Indexed: 11/17/2022] Open
Abstract
Background Head injury in England is common. Evidence suggests that socio-economic factors may cause variation in incidence, and this variation may affect planning for services to meet the needs of those who have sustained a head injury. Methods Socio-economic data were obtained from the UK Office for National Statistics and merged with Hospital Episodes Statistics obtained from the Department of Health. All patients admitted for head injury with ICD-10 codes S00.0–S09.9 during 2001–2 and 2002–3 were included and collated at the level of the extant Health Authorities (HA) for 2002, and Primary Care Trust (PCT) for 2003. Incidence was determined, and cluster analysis and multiple regression analysis were used to look at patterns and associations. Results 112,718 patients were admitted during 2001–2 giving a hospitalised incidence rate for England of 229 per 100,000. This rate varied across the English HA's ranging from 91–419 per 100,000. The rate remained unchanged for 2002–3 with a similar magnitude of variation across PCT's. Three clusters of HA's were identified from the 2001–2 data; those typical of London, those of the Shire counties, and those of Other Urban authorities. Socio-economic factors were found to account for a high proportion of the variance in incidence for 2001–2. The same pattern emerged for 2002–3 at the PCT level. The use of public transport for travel to work is associated with a decreased incidence and lifestyle indicators, such as the numbers of young unemployed, increase the incidence. Conclusion Head injury incidence in England varies by a factor of 4.6 across HA's and PCT's. Planning head injury related services at the local level thus needs to be based on local incidence figures rather than regional or national estimates. Socio-economic factors are shown to be associated with admission, including travel to work patterns and lifestyle indicators, which suggests that incidence is amenable to policy initiatives at the macro level as well as preventive programmes targeted at key groups.
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Affiliation(s)
- Alan Tennant
- Academic Unit of Musculoskeletal and Rehabilitation Medicine, The University of Leeds, UK.
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